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| surfboardt. surfboardt. |
Kanye is a relatively large village: many homes have indoor plumbing, and there are a variety of conveniences like grocery stores, gas stations and clinics, to name a a few.
We arrived at the Kanye education center late Sunday morning, in the cloudiest and perhaps coldest weather we'd experienced since arriving, some of us in light sweaters--low 70s I'm guessing. We chose our host families by randomly drawing names, except Adam. One family had requested a boy. I drew a name that would have taken me all week to learn, but my kindly host mom told me instead to call her Mma Lorato. Two high-school-aged girls live with Mma Lorato: Molebolo is 15 and attends secondary school; Odidi is 17 and attends college, a two-year precursor to university which she will complete when she is 19. The girls do most of the housework, seemingly in exchange for food and shelter, but I didn't ask about the exact arrangement with their families. They explained that they used to have a maid, but that she was fired recently so the two of them have had to do more around the house, like dishes, sweeping, mopping, cleaning their shared bathroom, etc. Cleaning and other tasks are complicated though by the fact of water shortages and infrastructural issues in Botswana: the water is off much of the time. When the water comes on the girls quickly fill dozens of plastic jugs with water to use for dishes, cooking, bathing and flushing the toilet. The latter incidentally was a pivotal activity for me this week, and I felt bad using the precious resource on my high-maintenance bowels.
Last Sunday night I started to feel chills and body aches and went to bed around 8pm. I woke up with much of the same plus a headache and cramps. I was planning on toughing it out until I passed by a poster in the main clinic that listed the symptoms of malaria: fever/chills, aches, headache... I wasn't going to mess around with that kind of coincidence. Bonolo, our de facto on-site director, driver for all eleven of us in her personal combi, and everyone's mother, took me to the private clinic after dropping everyone else off at their volunteer sites. Oh, and after she picked up her sour milk for making bogobe (sorghum), and transporting a couple of her extended family members to their destinations, all the while calling shrilly to people she knew as we passed--what seemed to be about 25% of the village's residents. But we made it there eventually. On village time. And then we sat in the waiting room for a couple of hours.
The doctor was cold, impersonal, kind of scary, and a quite arrogant. No one took my vitals, although this is routine in the government clinics. He took my weight and listened to my heart with his stethescope, but even though I complained of fever and aches he didn't take my temperature. When Bonolo asked him to do so on my behalf, he told her that he didn't need to because he felt my skin when he was listening to my heart and he could tell I didn't have a fever. I insisted he take my temperature. I had a fever. He then prescribed a drug for fever and aches and an antibiotic, and a malaria test. We had to return two days later for the malaria result--though at this point it was clear, as I was upright and functional, that I didn't have malaria. After waiting outside for the clinic to open at 8am, we waited for an hour inside the clinic for the doctor to arrive. The receptionist then received a call and nonchalantly relayed news that the doctor would not be in until 10:30. Not sure how this was an acceptable state of affairs, but I decided just to have Bonolo's son come pick me up and take me to the NGO I was supposed to visit that day so I didn't have to miss yet another day of experience. Bonolo brought me my negative result later, since she had to wait with another girl who needed to see the doctor anyway. A few others were sick too, but not severly enough to need a doctor.
After two days of taking meds and pushing through, my stomach cramps took over as my most bothersome symptom and I spent Wednesday night in pain, back and forth from the bathroom, and finally Thursday morning was able to sleep peacefully--while missing clinicals again.
I definitely felt the most homesick during my homestay than I have since arriving. Being sick so far away from home is frightening, especially when the health system is different and I didn't know what to expect. The familiar is so soothing in times of distress. I feel like that fact in itself is a solid argument for strong primary care in any medical system, where people have rapport with a, familiar, compassionate family physician. But I mostly just missed my loved ones of course, and the familiar, comforting care I knew they would provide. In my stupor while I was ill I thought about how I'd like to become involved with an organization that provides psychosocial support to patients (especially those with fewer visitors), for example organizations that bring dogs to visit nursing home patients. Something to consider when I get home. Also something to consider about our medical system: certainly money toward research is important, but what about those who are already sick? Emotional support is so important for the wellbeing of those who are ill, and warrants the allocation of resources. (shout out to Mariah-- your capstone really got me thinking about this issue!)
Anyway, being sick was a big part of my week, but definitely not all of it. I still got to enjoy our group tour of Kanye on Tuesday. First stop was the Kgotla, the center of tribal governance, where the Kgosi (chief) resides, the tribal council meets, and where an administrative center attends to the details of the local government. A tribal council meeting was actually in session when we arrived; we had to be quiet as it was outdoors under a large tent . A husband and his mistress were on trial for "homewrecking," a legitimate civil offense for which they were both found guilty, and will have to pay a sum to the wife.
We also visited the gorge, which features prominently in local lore. Some say a giant snake lives in the gorge and that people have been know to disappear. Those accused of witchcraft were also dropped to their deaths into this gorge up until the mid 20th century. When we arrived inside we found a group of three people who were eating and drinking wine following the sacrifice of a lamb for religious purposes. The hadn't yet covered the blood splatter, and the remains were in a 5-gallon bucket that they carried out of the gorge.
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| Nahara, Krista, Anandi, and I (we hiked in skirts because they were required for entry into the Kgotla) photo cred: Anandi |
Last stop was the dam. A confusion in terminology led us to expect what Americans call a dam: a concrete structure that holds back water, of which there was none in sight. Apparently the Batswana mean the water itself, basically what we would call a reservoir. We asked Thebo, Bonolo's son, why it was called a dam rather than a lake: he said he thought a lake had water that was always moving. We said we call that a river. He said he thought they were the same thing. Perhaps the scarcity of bodies of water in Botswana has led to less precise classification. And of course these things all depend on one's viewpoint. A note on religion: a Peace Corps volunteer we met mentioned that people are frequently baptized in the dam (85% of Batswana are Christian). He has heard of several drownings since he arrived in Kanye, and mentioned that many people don't know how to swim. However the explanation is typically that evil spirits/demons are somehow involved. Non-sceintific explanations that are unfamiliar to Westerners frequently figure in other capacities as well, including within public health issues like HIV and AIDS. Effective comprehensive programs (will) have to take into consideration the cultural dimensions of the disease with regard to the varied viewpoints and belief systems within Botswana.
Every morning between 6:30 and 7:30 Bonolo, and sometimes her son Thebo, picked all of us up at our host families' homes in the combi. The commute was anything but ordinary by U.S. standards! In Kanye, every vehicle is an all-terrain vehicle. Most of the roads are dirt, with gullies carved out by flooding from the rain, large rocks strewn throughout, sharp corners, and impossibly tight maneuvers with oncoming vehicles. My fondest memory from Kanye will probably be bouncing along the roads, everyone talking and laughing just after the sorbet sunrise broke into a bright, cool, morning, and singing through the afternoon with the breeze from an open window stirring our hair and cooling our skin as we cruised to our various village destinations. Thebo's driving was particularly interesting--zipping around Kanye was oddly reminiscent of the Indiana Jones ride at Disneyland (ok, major privilege moment, but that's the best way I can think to relay it). Adding to the excitement, the starter (spark plug?) broke part way through the week and Bonolo didn't have time to get it fixed, so we had to push the combi in order to start it each time we stopped.
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| We love Bonolo! photo cred: Adam Zeelens |
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| photo cred: Anandi |
Mmamokhasi clinic was only busy until around 10:30am. The clinic is on top of a hill and public transportation in the area is limited so it mainly serves the immediate surrounding neighborhood and overflow from other, busier clinics. One day the nurse in charge of the triage room allowed me to do intakes, which included taking blood pressure, weight, temperature, and of course practicing my Setswana. I'm getting to the point where I can carry on a very basic conversation and it certainly makes a difference during interactions with locals. Most patients had evident appreciation of my efforts, which is encouraging. Although I've noticed that children have difficulty understanding me--I guess my American accent is pretty thick.
One day at the clinic I spent most of my time in the Child Welfare room. From birth to five years of age, children go to the clinic for a checkup: nurses measure weight and height, ask parents about the child's nutrition and method of feeding (breastfeeding, formula, other milk, solid foods, etc), whether the family has received a government food ration (ideally including beans, fortified paleche, also known as pap or maize-meal, and one or two other items, but budget cuts have made these rations inconsistent), how much of the ration the child consumed, and if the child is due for his or her biannual Vitamin A supplement. I was amazed by this comprehensive program which of course is free for all Batswana.
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| Kirsten and I at the entrance of the Mmamokhasi Clinic photo cred: Adam Zeelens |
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| Working hard... |
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One day during a lull at the clinic Adam and I went for a walk around the neighborhood:
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| The traditional sorghum beer... I have yet to try it |
Another day my group visited an NGO called BOFWA, the Botswana Family Welfare Association. While the nurse who provides most of the services was not in, we got to learn about BOFWA's mission and services and shadow a couple of representatives as they made home visits. BOFWA provides family planning services and reproductive health services as well as free HIV testing. They're associated with Planned Parenthood International, but one representative who is also in the Peace Corps conjectured that the government hasn't been aware of this association when it has given funds, as Botswana isn't particularly progressive regarding women's rights by Western standards---abortion is illegal, divorce laws are still unequal, etc. During our home visits the reps delivered several free boxes of 100 condoms to community members--however only men accepted the offer. During our downtime I got to experience HIV testing firsthand and was tested for HIV! Although the chances that I would be HIV positive are essentially nil, my heart still raced as I awaited the results of my rapid test, after the counselor (a smiley young woman my age named Lilly) pricked my finger, used a pipette to apply blood drops to two different plastic tests (they look sort of like smaller versions of a pregnancy test), and applied the reactant solutions to the tests. I can't even imagine the anxiety individuals must experience when they believe they may have been exposed to the virus. The rapid test assays for antibodies to the virus, so only produces a positive result if an individual is no longer in the 12-week acute phase following infection when viral load is very high but the body still has not been able to react with the production of antibodies.
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| Valentine's Day full moon |
I really enjoyed my time in the village--it was refreshing and interesting to experience a different pace and style of life. When Mma Lorato and the girls weren't busy with chores they seemed to be content just watching TV. I'd be really interested to know what an even more rural village would be like--without power, without running water. Though I honestly did miss the bustle of Gabs and UB. I realized that coming back felt like coming home, which was really comforting. In just 5 week I've come so far in adjusting; I've found myself thinking about how strange my return to the U.S. will feel in many ways. But of course I still have a long way to go before then.
Go siame, tsala ba me!
(Goodbye, my friends!)
Here's a toast to a complete recovery from your illness plus no malaria or HIV.
ReplyDeleteMay the rest of your days abroad be free of the yearning for apple juice and cinnamon toast.
Mom
Haha, thanks mom. =]
ReplyDelete